Is medical marijuana covered by health insurance?

With more people using medical marijuana, it isn’t surprising that they would want to be covered under their benefits. (Photo: iStock)

Medical marijuana has been legally prescribed in Canada for 15 years as a remedy for people with serious illnesses.

With more people using medical marijuana, it isn’t surprising that users would want coverage under their health benefits/insurance.

What is the health insurer’s position on covering the costs of those who are authorized to use it and are insured under a plan?

So far, the position has been that they usually do not insure people for medical marijuana, because it doesn’t have a drug identification number, as can be seen in the next case.

A unionized fire fighter filed a grievance against his employer because his spouse was denied reimbursement for prescribed medical marijuana. He claimed that as an employee he was entitled to health and welfare benefits which were outlined in the collective agreement and the denial of his claim by the insurer and his employer violated the agreement.

The main issue in this case was that even though Health Canada regulates medical marijuana, it doesn’t issue drug identification numbers for it and without that it would not be covered under the extended health benefits plan.

Health Canada issues a DIN for authorized drugs, which can be both prescription and over-the-counter medication. If a drug is sold without a DIN, it is not in compliance with Canadian law.

That is precisely the situation medical marijuana is at this moment. It hasn’t been legalized yet but people are using it for legitimate medical purposes.

The arbitrator ended up upholding the denial of the reimbursement and found no violation of the collective agreement, because the agreement was clear that in order for there to be reimbursement for a prescribed drug it must have a DIN.

It’s important to mention that even though the employee in this case was unsuccessful in getting reimbursed, the Ontario Workplace Safety and Insurance Appeals Tribunal has looked at the issue differently. The tribunal has ruled in similar cases that employees should be reimbursed for medical marijuana.

Whatever the case may be, new federal marijuana legislation will be introduced in Spring 2017 and if the new law decriminalizes marijuana, then both Health Canada and health insurers may have to rethink their position.